Evaluation of a Quantitative Food Frequency Questionnaire for 5-Year-Old Children in an Asian Population

Published:December 19, 2019DOI:



      Food frequency questionnaires (FFQs) are often used to assess dietary intakes due to their ability to assess intake over extended periods, their low respondent burden, and their cost-effectiveness. A quantitative FFQ that includes locally appropriate food items for 5-year-old children in a multiethnic Asian population was developed, but its validity has not previously been evaluated.


      To evaluate the relative validity of a newly developed FFQ as a dietary assessment tool for 5-year-old children in a multiethnic Asian population.


      The 112 –food item FFQ was administered by trained interviewers to caregivers of children. Frequency of food items consumed in the previous month and portion size information were collected. The FFQs were evaluated against 3-day nonweighed diet records (DRs) completed by caregivers.


      The dietary data of 361 children aged 5 years from the Growing Up in Singapore Towards Healthy Outcomes mother-offspring cohort were collected in 2015-2016.

      Main outcome measures

      Nutrients of interest included energy, macronutrients, fiber, cholesterol, vitamin A, beta carotene, calcium, and iron, calculated from the FFQs and DRs.

      Statistical analyses performed

      Nutrient intakes according to FFQs in relation to DRs were assessed using Pearson’s correlation, Lin’s concordance, Bland-Altman plots, quintile joint classification, and Cohen’s κ statistics.


      The highest energy-adjusted correlation (Pearson’s r=0.71) and concordance (Lin’s concordance=0.69) were observed for calcium. Fiber, saturated fat, polyunsaturated fatty acids (PUFA), cholesterol, and iron also showed correlation coefficients and concordance of at least 0.40. Bland-Altman plots suggested no substantial bias across ranges of intakes for the nutrients with correlations and concordance of 0.40 or above. Quintiles joint classification showed substantial agreement for calcium (κ=0.66), and moderate agreement for iron, fiber, saturated fat, polyunsaturated fat, and beta carotene (κ=0.59, 0.54, 0.49, 0.44, 0.43, respectively).


      The newly developed FFQ is in reasonable agreement with DR for estimating intakes of calcium, fiber, saturated fat, PUFA, cholesterol, and iron. In addition, the FFQ is able to classify children according to quintiles of nutrient intakes, with moderate to substantial quintile agreements between FFQ and DR for calcium, iron, fiber, saturated fat, PUFA, and beta carotene. To assess the remaining nutrients, DR method is recommended instead of the FFQ.


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        • Popkin B.M.
        Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases.
        Am J Clin Nutr. 2006; 84: 289-298
        • Livingstone M.B.E.
        • Robson P.J.
        • Wallace J.M.W.
        Issues in dietary intake assessment of children and adolescents.
        Br J Nutr. 2004; 92: S213-S222
        • Collins C.E.
        • Watson J.
        • Burrows T.
        Measuring dietary intake in children and adolescents in the context of overweight and obesity.
        Int J Obes. 2010; 34: 1103-1115
        • Cade J.E.
        • Burley V.J.
        • Warm D.L.
        • Thompson R.L.
        • Margetts B.M.
        Food-frequency questionnaires: A review of their design, validation and utilisation.
        Nutr Res Rev. 2004; 17: 5-22
        • Cade J.
        • Thompson R.
        • Burley V.
        Warm D. Development, validation and utilisation of food-frequency questionnaires—A review.
        Public Health Nutr. 2002; 5: 567-587
        • Shim J.-S.
        • Oh K.
        • Kim H.C.
        Dietary assessment methods in epidemiologic studies.
        Epidemiol Health. 2014; 36: e2014009
        • Ortiz-Andrellucchi A.
        • Henríquez-Sánchez P.
        • Sánchez-Villegas A.
        • Peña-Quintana L.
        • Mendez M.
        • Serra-Majem L.
        Dietary assessment methods for micronutrient intake in infants, children and adolescents: A systematic review.
        Br J Nutr. 2009; 102: S87-S117
        • Jayawardena R.
        • Byrne N.M.
        • Soares M.J.
        • Katulanda P.
        • Hills A.P.
        Validity of a food frequency questionnaire to assess nutritional intake among Sri Lankan adults.
        SpringerPlus. 2016; 5: 162
        • Lovell A.
        • Bulloch R.
        • Wall C.R.
        • Grant C.C.
        Quality of food-frequency questionnaire validation studies in the dietary assessment of children aged 12 to 36 months: A systematic literature review.
        J Nutr Sci. 2017; 6: e16
        • McPherson R.S.
        • Hoelscher D.M.
        • Alexander M.
        • Scanlon K.S.
        • Serdula M.K.
        Dietary assessment methods among school-aged children: Validity and reliability.
        Prev Med. 2000; 31: S11-S33
        • Kobayashi T.
        • Kamimura M.
        • Imai S.
        • et al.
        Reproducibility and validity of the food frequency questionnaire for estimating habitual dietary intake in children and adolescents.
        Nutr J. 2011; 10: 27
        • Kobayashi T.
        • Tanaka S.
        • Toji C.
        • et al.
        Development of a food frequency questionnaire to estimate habitual dietary intake in Japanese children.
        Nutr J. 2010; 9: 17
        • Poh B.K.
        • Ng B.K.
        • Haslinda M.D.S.
        • et al.
        Nutritional status and dietary intakes of children aged 6 months to 12 years: Findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia).
        Br J Nutr. 2013; 110: S21-S35
        • Soh S.-E.
        • Tint M.T.
        • Gluckman P.D.
        • et al.
        Cohort profile: Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study.
        Int J Epidemiol. 2014; 43: 1401-1409
        • Willett W.
        Nutritional Epidemiology. 3rd ed. Monographs in Epidemiology and Biostatistics.
        Oxford University Press, New York, NY2012
        • Lim G.H.
        • Toh J.Y.
        • Aris I.M.
        • et al.
        Dietary pattern trajectories from 6 to 12 months of age in a multi-ethnic Asian cohort.
        Nutrients. 2016; 8: 365
        • Chong M.F.-F.
        • Chia A.-R.
        • Colega M.
        • et al.
        Maternal protein intake during pregnancy is not associated with offspring birth weight in a multiethnic Asian population.
        J Nutr. 2015; 145: 1303-1310
      1. Dietplan [computer program]. Version 6. Forestfield Software, West Sussex, UK2015
        • Singapore Health Promotion Board
        Energy & nutrient composition of food.
        (Published March 14, 2011. Accessed November 5, 2018)
        • Watson J.F.
        • Collins C.E.
        • Sibbritt D.W.
        • Dibley M.J.
        • Garg M.L.
        Reproducibility and comparative validity of a food frequency questionnaire for Australian children and adolescents.
        Int J Behav Nutr Phys Act. 2009; 6: 62
        • Marcinkevage J.
        • Mayén A.-L.
        • Zuleta C.
        • DiGirolamo A.M.
        • Stein A.D.
        • Ramirez-Zea M.
        Relative validity of three food frequency questionnaires for assessing dietary intakes of Guatemalan schoolchildren.
        PLoS One. 2015; 10: e0139125
        • Lin L.I.-K.
        A concordance correlation coefficient to evaluate reproducibility.
        Biometrics. 1989; 45: 255-268
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Fleiss J.L.
        • Cohen J.
        The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability.
        Educ Psychol Meas. 1973; 33: 613-619
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
      2. Stata/IC [computer program]. Version 15.1. StataCorp, College Station, TX2017
        • Zhiwei T.
        Educational profile of Singapore resident non-students, 2002-2012. Singapore Department of Statistics.
        (Published March 2013. Accessed May 3, 2019)
        • Lombard M.J.
        • Steyn N.P.
        • Charlton K.E.
        • Senekal M.
        Application and interpretation of multiple statistical tests to evaluate validity of dietary intake assessment methods.
        Nutr J. 2015; 14: 40
        • Sahashi Y.
        • Tsuji M.
        • Wada K.
        • Tamai Y.
        • Nakamura K.
        • Nagata C.
        Validity and reproducibility of food frequency questionnaire in Japanese children aged 6 years.
        J Nutr Sci Vitaminol (Tokyo). 2011; 57: 372-376
        • Vioque J.
        • Gimenez-Monzo D.
        • Navarrete-Muñoz E.M.
        • et al.
        Reproducibility and validity of a food frequency questionnaire designed to assess diet in children aged 4-5 years.
        PLoS One. 2016; 11: e0167338
        • Matos S.M.A.
        • Prado M.S.
        • Santos C.A.S.T.
        • et al.
        Validation of a food frequency questionnaire for children and adolescents aged 4 to 11 years living in Salvador, Bahia.
        Nutr Hosp. 2012; 27: 1114-1119
        • Rankin D.
        • Hanekom S.
        • Wright H.
        • MacIntyre U.
        Dietary assessment methodology for adolescents: A review of reproducibility and validation studies.
        South Afr J Clin Nutr. 2010; 23: 65-74
        • Marques-Vidal P.
        • Ross A.
        • Wynn E.
        • Rezzi S.
        • Paccaud F.
        • Decarli B.
        Reproducibility and relative validity of a food-frequency questionnaire for French-speaking Swiss adults.
        Food Nutr Res. 2011; 55: 5905
        • Crespo Escobar P.
        • Calvo Lerma J.
        • Hervas Marin D.
        • et al.
        Development and validation of two food frequency questionnaires to assess gluten intake in children up to 36 months of age.
        Nutr Hosp. 2015; 32: 2080-2090
        • Villena-Esponera M.P.
        • Moreno-Rojas R.
        • Romero-Saldaña M.
        • Molina-Recio G.
        Validation of a food frequency questionnaire for the indigenous Épera-Siapidara people in Ecuador.
        Nutr Hosp. 2017; 34: 1368-1375
        • Wakai K.
        • Date C.
        • Fukui M.
        • et al.
        Dietary fiber and risk of colorectal cancer in the Japan collaborative cohort study.
        Cancer Epidemiol Biomarkers Prev. 2007; 16: 668-675
        • Warensjö E.
        • Byberg L.
        • Melhus H.
        • et al.
        Dietary calcium intake and risk of fracture and osteoporosis: Prospective longitudinal cohort study.
        BMJ. 2011; 342: d1473


      R. Sugianto is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.


      M. J. Chan, is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.


      B. C. Tai is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.


      M. F.-F. Chong is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.


      S. F. Wong is from the Agency for Science, Technology and Research, Singapore.


      L. P.-C. Shek is from the Yong Loo Lin School of Medicine, National University of Singapore, Singapore.


      Y. S. Chong is from the Yong Loo Lin School of Medicine, National University of Singapore, Singapore.


      K. H. Tan is from the Duke-NUS Medical School, Singapore.


      K. M. Godfrey is from the NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.